266 PINE ST ROOF 'X�
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ROOF NON SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: ROOF18-0023
Description: metal re-roof
Estimated Value: 10000
Issue Date:
Expiration Date:
PROPERTY ADDRESS:
Address: 266 PINE ST
RE Number: 1705520010
PROPERTY OWNER:
Name: HARMON HUBERT G JR LIFE ESTATE
Address: 266 PINE ST
ATLANTIC BEACH, FL 32233-4014
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: JUSTIN LARSEN CONSTRUCTION INC
Address: 4670 Hedgehog Street
MIDDLEBURG, FL 32068
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions
applicable to this property that may be found in the public records of this county, and there may
be additional permits required from other governmental entities such as water management
districts, state agencies, or federal agencies.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
I illj- City of Atlantic Beach APPLICATION NUMBER
2 Building Department (To be assigned by the Building Department.)
SS
>1 800 Seminole Road
Atlantic Beach, Florida 32233-5445 �00f_ CC 6-
Phone (904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us I
APPLICATION REVIEW AND TRACKING FORM
Property Address: (40 P't S_� PqQ�j�ent review required Yes No
Buildin6- )
Applicant: J o8i mc*�) Planning &Zoning
Tree Administrator
Project: M oo Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt VJ
Other Agency Review or Permit Required Date
L'IL"
Florida Dept. of Environmental Protection of Permit Verified By
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: YA"pproved. []Denied. []Not applicable
(Circle one.) Comments:
(!��Dl
PLANNING & ZONING Reviewed by: Date: V00010V
TREE ADMIN. Second Review: F]Approved as revised. FIDenied.V ONot applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. ElDenied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
c i�� Building Permit Application Updated 12/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845
Job Address: Ve A4W -P-,1CJ,, EL 5ZZ33 Permit Number: �cc F 1 ,� -oo�r
Legal Description 10- I L a RE#
Valuation of Work(Replacement Cost)$ 1 ()C)C) 00 Heated/Cooled SIF Non-Heated/Cooled
Class of Work(Circle one): New Addi<o=Alteration Repair ,Pool Window/Door
Use of existing/proposed structure(s)(Circle one): Commerci Residenti
es k N/�)
If an existing structure,is a fire sprinkler system installed?(Circle one es
Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed: 0- N16 )3, 4 e
cc c A
7- C
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: 14L)b"! UM-oa0&� Address: 'g6i� At, e- 5� 6,f1jdj_,Fj c,
city_aRA,,,c Kiacy, State Zip '_� Z-Z-3 3 —Phone 9b0
E-Mail
Owner or Agent(if Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company:Qa L,1e_Sr-_A) Qualifying Agent:_,_17yJ 5 4-A-) LA lz�ct_)
Address$. It, tl-w�kw_ City .4d,,),Qtek,)a,(_ State P77 Zip
Office Phone Job Site/Contact Number Ofo A L T. - 14 5/1
State Certification/Registration# E-Mail C-On
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
__X-empt/!14urer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit(o d64*w-wo'r/k and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER ATTO Y BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) ina rure of Contractor)
(including contractor)
day of
Signed and sworn to(or affirmed)befo e this" day of orn to(or affirm9l)before me this2
W64-101�, 'r;q� by O,n 5-
Jq 10 FAA
a'4
(Signature oj*ofary) nature of NokrIA
]Personally Known OR Personally Known OR DAVICI NATHAN SLATOFF
DAk'fr'19A'TLJ !,TOFF k4" FF935021
J Produced Identification L Produced Identification
�e;y
Type of Identification: Nr2 ' *?' �ype of Identification:
"L.'s"'iovember MS.Z,
Pe r-/77� 7/ -#1P0-oF1E--c0a3
NOTICE OF COMMENCEMENT
State of Folio No.
County of 10 V LML, OFFIGt COWx
To Whom It May Concern.
The undersigned hereby informs you that unprovements will be made to certain real property,and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF COMMENCENffiNT.
Legal Description of property being improved:_ID �5
Sce--
Address of property being improved: J�� ej IL2,,C Z2-3
AJLA.-j4-,s- 3 -3
General description of improvements: jZr.— goo F7'
Owner: Lg-p-k 4'e-4yLotj Address: e— S-(- ,j-tr
OwiiWs interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor:
Address: LfG 7�0 ee�o"r,
Fax No:
Telephone No.:'90Y )2-?--Y34
3ur�of any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida,other than himselt designated by owner upon whom notices or other documents may be
served: Name:
Address:
Telephone No: FaxNo:
In addition to himselt owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signe . Date: 2 12J-11,Y
Before this ?a- day of in the �fDuval,
Of Florida,has personally appeared MhIn
Doc#2018047508,OR BK 18297 Page 2025, Notary public at Large,State Fl rid' uval.
Number Pages:1 My commission L%xpires:
Recorded 02/28/2018 12:56 PM, Personally Known: or
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Produced Identific *o VID NATHAN
COUNTY
RECORDING $10.00 My COMMISSION#FF935MI
EXPIRES November 09.2()Jg